Why women’s malnutrition in India is not just about hunger

India’s nutrition challenge among women is no longer limited to hunger or weight loss. A new multi-centre study funded by the Indian Council of Medical Research (ICMR) and published in the Wiley Online Library shows that undernutrition, micronutrient deficiency and early metabolic risk are big contributors. 

Published in the Wiley Online Library, the study was conducted by ten Indian medical institutions, including Sher-i-Kashmir Institute of Medical Sciences, Srinagar; All India Institute of Medical Sciences, New Delhi; Osmania Medical College, Hyderabad and National Institute for Research in Reproductive & Child Health, Mumbai.

The findings show how diets that are low in protein and essential micronutrients but high in inexpensive calories, combined with more sedentary work, heat stress, and chronic physical and mental strain, are reshaping women’s health. As a result, anaemia often overlaps with vitamin deficiencies and early metabolic risk, but this combination is rarely detected by health systems that look at problems in isolation.

National Family Health Survey (NFHS) analyses and peer-reviewed Indian research show that this overlap is in fact widespread, with anaemia frequently accompanied by vitamin B12 and vitamin D deficiencies, and metabolic risks emerging earlier in life. Debt, food insecurity, gendered care burdens and irregular work further constrain women’s ability to eat well or seek timely care, creating a complex form of nutritional distress.

Despite being classified as healthy, over four in ten women in the Wiley Online Library study, reported by The Times of India, had both abnormal body weight and anemia, nearly half had depleted iron stores, more than a third had vitamin B12 deficiency, and two-thirds were deficient in vitamin D. 

Importantly, over 40% also showed signs of insulin resistance, an early marker of metabolic dysfunction, even within the 18 - 40 age group. The risk intensifies with age, with women in their thirties showing higher odds of combined nutritional and metabolic problems, demonstrating how these conditions quietly accumulate over time rather than appearing suddenly.

The risks compound with varying levels of vulnerability.

In India’s tribal-dominated districts, women’s nutrition is much higher than the national averages. NFHS-4 data from a multi-district study in the tribal regions of Bastar (Chhattisgarh), Koraput (Odisha) and West Singhbhum (Jharkhand) found that 80% or more women aged 18-59 were anaemic, and large numbers of them were chronically underweight, with 44% of women in Koraput and 27% in West Singhbhum recording a body mass index below 18.5 kg/m² - a measure of chronic energy deficiency. 

Evidence from across states and occupational groups suggests that this pattern is not evenly distributed. Women’s malnutrition in India is deeply tied to where they live, the work they do, and how early nutritional disadvantage intersects with adult livelihoods.

NFHS-5 data from Maharashtra, Bihar and Uttar Pradesh records high anemia prevalence among women in rural and low-income households, particularly those dependent on informal agricultural and daily-wage labour, where irregular earnings and seasonal food insecurity disrupt access to nutrition and food. 

In cities such as Delhi, Bengaluru and Chennai, occupational health studies among garment workers, factory workers and domestic workers have linked long working hours, sedentary routines, skipped meals and dependence on inexpensive processed foods to poor nutritional outcomes, alongside limited access to preventive healthcare.

In tribal and remote districts of Odisha, Chhattisgarh and Jharkhand, longitudinal field studies published in journals such as the Journal of Health, Population and Nutrition show that undernutrition often begins in adolescence and persists into adulthood, deepening nutritional depletion over time. Broader reviews of tribal nutrition, including analyses of Particularly Vulnerable Tribal Groups, find that tribal women face substantially higher rates of anaemia and chronic undernutrition than non-tribal populations. 

These patterns are linked to entrenched poverty, reliance on rain-fed agriculture, weak health and nutrition service outreach, and irregular delivery of state support. Even in tribal regions where body weight varies, multiple regional analyses show that more than half of women remain anaemic, driven by poor diet quality, low literacy, limited healthcare access and long-standing socio-economic exclusion.

Responding to this layered form of malnutrition requires moving beyond isolated health interventions. Experts say women’s nutrition cannot be fixed by healthcare alone, but needs coordinated action across food systems, labour conditions and social protection.

Researchers from ICMR and analyses published in journals such as The Lancet Global Health and British Medical Journal stress the need for integrated screening that goes beyond haemoglobin levels to include micronutrient status and early metabolic markers, particularly for women of reproductive age.

Nutrition scholars have also pointed out that programmes with an excessive, narrow focus on calorie intake or iron supplementation are poorly equipped to address deficiencies in vitamin B12 and vitamin D, or the early onset of insulin resistance.

What’s equally significant is addressing the social and occupational conditions that shape women’s nutrition. There is a need for stronger outreach in tribal and remote regions, better continuity in nutrition services, and interventions that account for women’s work patterns, heat exposure and care burdens.

Experts say women’s nutrition cannot be fixed by healthcare alone. Without coordinated action across food, work and social protection systems, nutritional gaps continue to accumulate, often becoming harder to reverse later in life.